Desquamative Lesion of the Nose and Lip

Abstract

A 28-year-old male presented to the Department of Oral Medicine and Radiology for the evaluation of multiple asymptomatic erythematous lesions on the ala of nose and lips, which he noticed one year ago. He had no history of fever, joint pain, cough, weight loss, eye complaints, or any other systemic complaints. Past and family history were not contributory. There was no significant drug history. General physical and systemic examinations were normal. Facial examination revealed a large erythematous lesion extending from the ala to the apex of the nose measuring 3 × 2 cm. Another lesion was seen on the upper lip. Chest X-ray, routine hemogram, serum, and 24-hour urinary calcium were normal. Mantoux test was negative. Slit skin smears for acid-fast bacilli and Leishmania donovani bodies were negative. An incisional biopsy under local anesthesia was performed from the ala of the nose for microscopic evaluation, which revealed non-caseating granulomas comprised of epitheloid cells and few Langhans giant cells with focal areas of lymphocytic infiltration. A diagnosis of lupus pernio (cutaneous sarcoidosis) without systemic involvement was made. The patient was treated with hydroxychloroquine 200 mg once daily and topical fluticasone. The patient responded with almost complete resolution at the end of seven months treatment.

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